Philadelphia --Gavin Perrin has his work cut out for him this semester. The Susquehanna University sophomore is taking a hefty 22 credits in a demanding accounting program. But as he planned to head back to campus this month, the pandemic permitting, Perrin was thinking about the fun stuff: seeing all the friends he made last year, moving in with his new roommates, playing sports.
It's a far cry from Perrin's high school days.
"I was that type of kid in high school who would rather be anywhere else," Perrin said.
It's not that his high school was a bad place. The difference is him: "I feel like a new man."
Between his junior year of high school and his freshman year of college, Perrin lost more than 200 pounds. At 5-foot-10, the 19-year-old from Turbotville, Northumberland County, is down to 230 pounds. He says he feels healthier, more confident.
Gavin Perrin is photographed at his Turbotsville, Pennsylvania home Sept. 3, 2020. He has lost a substantial amount weight through bariatric surgery.(Photo: TOM GRALISH, TNS)
Perrin accomplished that through a lot of hard work that included diet change and exercise. But it probably wouldn't have happened so quickly without another strategy that's used to help only a small number of the estimated 4.5 million American children and teenagers with severe obesity: bariatric surgery. That's despite growing research that it is an effective, safe way to deal with a health problem that has reached epidemic proportions. Obesity increases the risk of hypertension, liver disease, diabetes, sleep apnea, and many other health problems, even among teens.
The American Academy of Pediatrics in December came out in support of bariatric surgery as an "evidence-based effective treatment of severe obesity" and said greater access to the surgery for pediatric patients ages 13 and older "is urgently needed." There is no authoritative count of how many of these surgeries are performed each year on teenagers, but estimates range from 450 to about 1,600. Most experts agree it's less than 1% of the youngsters who might benefit.
"It's definitely underutilized," said Elizabeth Parks Prout, medical director of Children's Hospital of Philadelphia's Adolescent Bariatric Surgery Program, a joint effort with the Hospital of the University of Pennsylvania. "We're not treating everyone who needs treatment, unfortunately."
'A tool for change'
Most teens who undergo bariatric surgery, like Perrin, have the gastric sleeve procedure, in which 70% to 80% of the stomach is permanently removed. Not only is the size of the stomach greatly reduced, but, especially significant, the surgery also affects hormonal balance, including the production of ghrelin, often referred to as the hunger hormone.
Surgery along with lifestyle changes result in a 20% to 30% average weight loss for adolescent patients, Prout said. Lifestyle changes alone aren't effective for long-term obesity treatment, many experts say.
A growing body of research shows there are few post-bariatric surgery complications, though many programs recommend nutritional supplements in response to concerns about postsurgery deficiencies.
Money, not safety, is one reason few teens get this surgery. It's not unusual for insurers to turn down adolescents for the surgery, according to the AAP, especially children from low-income families and children of color who may be stymied by complex, and at times costly, insurance appeals, or inconsistent coverage policies. These families may also lack access to a bariatric surgery program near them.
Some parents and patients fear going under the knife for something they might think could be handled without surgery. In addition, doctors involved in bariatric programs say other physicians often hesitate to refer younger patients, in part due to misunderstanding about the surgery.
"It's a surgery to help you to be able to be effective in the changes in your diet and exercise," Prout said. "The surgery is not a cure. The surgery is a tool for change."
Ann Rogers, director of the Penn State Surgical Weight Loss Program, said she thinks the stigma of obesity can extend to its treatment.
"Obesity isn't a choice. It's not a lifestyle people want to embrace," Rogers said. "It's a chronic and recurring medical condition, just like cancer. So if we have medical therapies that are designed to treat medical problems, we should use them."
'What am I waiting for?'
Lyndsey Gibb, 17, said she's always been "a bigger kid," at least since she was a toddler. "It was something that continued to get out of control as I grew when I hit the teenage years. That's especially when it got bad," she said.
The Dillsburg, York County, teenager tried various diet and exercise programs and went to multiple nutritionists, but nothing ever kept the weight off. Then a couple of years ago, her father had bariatric surgery. As her dad shed weight, she noticed other changes in him. He was more confident, less self-conscious about what he wore, less restricted in the things he would do. She decided she wanted that for herself.
Gibb had her surgery last December at Hershey Medical Center with Rogers. Since then, she's lost 115 pounds and intends to shed another 60. Her BMI went from almost 53 to 36. (Severely obese is considered to start at a BMI of 35 to 40.)
"I definitely feel a lot better, more so confidence-wise than health-wise," Gibb said. "Health-wise, I feel like I can do more, but just being more comfortable with what I look like and what I can wear makes me feel a lot better."
Gibb said she is excited that she can now wear stylish brands like Simply Southern that she always liked, but didn't come in her old size. She gave up riding horses because of her weight. She thinks that could be an option again. Just walking is more enjoyable.
She's beginning her senior year at Northern York High School. COVID-19 permitting, she's looking forward to the prom. Growing up in a rural area, Future Farmers of America is an important activity for her. It involves speaking in front of large groups of people.
"It will help if I feel better about how I look," she said. "I'll be more confident in what I'm doing, and hopefully I can even be better at what I'm doing because of it."
To those who would say she was too young to have this kind of surgery, she has a ready answer.
"What am I waiting for in my life? I've dealt with this for how many years now? My dad got it when he was 40-something years old. It's either I live with how I am and continue to go up and down, or give this a shot and be able to improve my quality of life sooner."
Gavin Perrin is photographed at his Turbotsville, Pennsylvania home Sept. 3, 2020. He has lost a substantial amount weight through bariatric surgery.(Photo: TOM GRALISH, TNS)
A new start
Perrin started his battle with weight at a young age, too. From ages 4 to 15, he participated in a medical weight-loss clinic program where he was given nutrition counseling. Finally, he was told there was nothing more they could do for him. By the time he got to the CHOP bariatric program, his BMI was 65.
"I had high blood pressure. I was borderline diabetic. Even walking around, my feet would burn up. I'd get tired really quick. I did try to play sports, but I couldn't last," Perrin said. "My size definitely bothered me. I could tell from a young age there were these differences, and I wasn't the same as everybody else."
Eating in public places made him feel self-conscious. "Even if they're not looking at you, you felt as if all eyes were on you."
In elementary and middle school, he had temper problems. He thinks his weight had something to do with it.
In high school, he found himself not wanting to go most of the time. He didn't ask anyone to the prom, and no one asked him.
He was a sophomore when he entered CHOP's program. He spent about a year in the presurgery program, which included education and lifestyle changes like a high-protein diet, vitamins, and medication. He had his doubts, given his past experiences. But for the first time, the pounds started coming off _ and staying off. He also was no longer prediabetic, and his blood pressure returned to normal.
"I thought, 'These are people I can trust.'"
By the time he arrived for freshman year at Susquehanna University, Perrin was very different from the kid who underwent weight-loss surgery.
"No one knew me. I could kind of reinvent myself," Perrin said.
After taking charge of his body and his health, "I felt like I could really talk to anybody. I didn't have trouble going out and meeting new people."
The high schooler who preferred to stay in his room became a college student who set goals of meeting as many people as he could. He was a regular at the campus gym. He joined the rugby team and played pickup basketball.
Last month, classes at Susquehanna started online, and Sept. 20 is his back-to-campus day. His roommates will be waiting. He's got a new job as an academic coach for freshman business students. Perrin's ready for whatever the future might bring.
"As long as coronavirus doesn't get in the way," he said, "I think these next couple years are going to be the best time of my life."
- The kids aren't all right: COVID-19-fueled stress eating, inequities, lack of fitness expected to boost obesity, experts say - USA TODAY - October 18th, 2020
- Hispanics live longer than most Americans, but will the US obesity epidemic change things? - The Conversation US - October 18th, 2020
- Obesity in children on the rise due to remote learning, study shows - WWLTV.com - October 18th, 2020
- How the pandemic is boosting the risk of childhood obesity WHYY - WHYY - October 18th, 2020
- Risk of severe Covid-19 high for obese people, regardless of other factors - Health24 - October 18th, 2020
- The COVID-19 pandemic emphasizes the need to manage patient obesity - Medical Economics - October 18th, 2020
- Learn About the Advice From FIGO on Obesity | Figo - International Federation of Gynecology and Obstetrics - October 18th, 2020
- Bariatric Surgery Associated with 3-Year Increase in Life Expectancy for Obese Patients - Endocrinology Network - October 18th, 2020
- funded study links adolescent brain differences to increased waist circumference - National Institutes of Health - October 18th, 2020
- National Pet Obesity Awareness Day puts spotlight on keeping furry friends at a healthy weight - KING5.com - October 18th, 2020
- Studies Begin to Untangle Obesitys Role in Covid-19 - The New York Times - September 29th, 2020
- Covid-19 has killed more people than obesity in the UK this year - Full Fact - September 29th, 2020
- Relation found between AMI and obesity < Hospital < - KBR - Korea Biomedical Review - September 29th, 2020
- Long-term impact of obesity on patient-reported outcomes and patient satisfaction after lumbar spine surgery: an observational study. - Physician's... - September 29th, 2020
- Recovered Covid patients just cant stop eating - The New Indian Express - September 29th, 2020
- Wellness Expert James Hill Says Healthy Is More Than Weight Loss - Healthline - September 29th, 2020
- Weight Gain Linked to Later Life Incident VTE - MD Magazine - September 29th, 2020
- 18 Percent Of Americans Don't Have Enough To Eat, Which Makes Them...Obese? - Science 2.0 - September 29th, 2020
- Food insecurity in the US increasingly linked to obesity - Medical News Today - September 28th, 2020
- U.S. Adult Obesity Rate Hits Highest Rate Ever Recorded - Club Industry - September 28th, 2020
- Mission: Readiness ties obesity to national security - News - Times Record - September 28th, 2020
- The Intersection Of Obesity, COVID-19, Social Justice And Mental Health - Club Industry - September 28th, 2020
- Experience of Polish Patients with Obesity in Contacts with Medical Pr | PPA - Dove Medical Press - September 28th, 2020
- Cleveland Clinic Study Identifies Weight-Loss Threshold for Cardiovascular and Survival Benefits in Patients with Obesity and Diabetes - Health... - September 28th, 2020
- Coronavirus pandemic could impact cancer rates and care in the future - WKTV - September 28th, 2020
- An obese heart is a silent risk - The Hippocratic Post - September 28th, 2020
- Nonalcoholic Fatty Liver Disease and Heart Failure: Is There a Connection? - Michigan Medicine - September 28th, 2020
- Should India adopt NOVA classification of food? - The Sunday Guardian - September 28th, 2020
- Obesity and the Bitter Pill of Truth - Medscape - September 23rd, 2020
- Obesity and COVID-19: A renewed call to address a growing crisis - World Bank Group - September 23rd, 2020
- Negative pressure wound therapy does not cut infection risk in obese women after cesarean delivery - National Institutes of Health - September 23rd, 2020
- Obesity linked to hospitalisation and ICUs for Covid-19 patients - The Irish Times - September 23rd, 2020
- New Research Shows Potential Utility of Growth Standards to Monitor Healthy Weight in Puppies and May Help Identify Puppies at Risk for Obesity -... - September 23rd, 2020
- SCOTUS, Sallys economic effects and obesity - AL.com - September 23rd, 2020
- Obesity can cause and be consequence of poor sleep - Westside Eagle Observer - September 23rd, 2020
- Health Education Week 2020: Opportunities and Advancements in Obesity Medicine - Medical Economics - September 23rd, 2020
- COVID-19 Recovery Analysis: Assisted Reproductive Technology Market | Increase in Rate of Infertility and Obesity-Related Cases to Boost the Market... - September 23rd, 2020
- Stephanie Yeboah: 'Obesity is a disgusting word... it's just used to scare people' - Telegraph.co.uk - September 23rd, 2020
- Diabetes, Obesity and other five risk factors that can lead to heart failure - India TV News - September 23rd, 2020
- Research finds out a new phenomenon of obesity with the multiple burden of malnutrition in India - Eastern Eye - September 23rd, 2020
- WHO launches guide to boost children's health and well-being in Russian-speaking countries - Russian Federation - ReliefWeb - September 23rd, 2020
- Obesity associated with a higher risk for dementia, new study finds - National Institute on Aging - September 20th, 2020
- Your Health First: Top underlying health conditions in North Dakota? Obesity and Type 2 diabetes - KX NEWS - September 20th, 2020
- US adult obesity at highest level ever recorded; Arkansas and Oklahoma rank in top five - 5newsonline.com - September 20th, 2020
- Coronavirus science | Week in review: 'Long Covid', obesity, and will the virus become seasonal? - Health24 - September 20th, 2020
- Mediterranean diet helps offset the health impacts of obesity - Earth.com - September 20th, 2020
- Obese people 70% more at risk of severe COVID-19: Assocham - The Indian Express - September 20th, 2020
- Could interaction between Covid-19 and pre-existing bacteria explain severity in the obese? - Health24 - September 20th, 2020
- Despicable to blame Government for Covid-19 death rate given obesity, says Tory peer - Evening Standard - September 20th, 2020
- If a heavyweight is morbidly obese why is he also fit to box? - Boxing News Online - September 20th, 2020
- Cancer Is on the Rise Among Young People - Discover Magazine - September 20th, 2020
- Letters to the Editor: Sept. 20 - Canon City Daily Record - September 20th, 2020
- Good nutrition can contribute to keeping COVID-19 and other diseases away - Kiowa County Press - September 20th, 2020
- Why COVID-19 is more deadly in people with obesityeven if they're young - Science Magazine - September 8th, 2020
- Higher obesity rates appear to contribute to higher bankruptcy rates in the United States - PsyPost - September 8th, 2020
- Worldwide Non-Invasive Fat Reduction Industry to 2025 - Increasing Prevalence of Obesity Presents Opportunities - ResearchAndMarkets.com - Business... - September 8th, 2020
- New evidence testosterone therapy is effective obesity treatment in men - New Atlas - September 8th, 2020
- Obesity is tied to greater risk of complications from COVID-19 - WWLTV.com - September 8th, 2020
- Pregnancy, Obesity and Nutrition Initiative (PONI): FIGO releases new Supplement - International Federation of Gynecology and Obstetrics - September 7th, 2020
- High Pleural Pressure Prevents Alveolar Overdistension and Hemodynamic Collapse in ARDS with Class III Obesity. - Physician's Weekly - September 7th, 2020
- Global Intragastric Balloon Market (2019 to 2028) - Rise in Government Initiatives Regarding Obesity Presents Opportunities - ResearchAndMarkets.com -... - September 7th, 2020
- Drugs That Fight Diabetes and Obesity May Treat Covid-19 - Bloomberg - September 6th, 2020
- COVID-19 Patients With Obesity Have Higher Viral Load, for Longer - Medscape - September 6th, 2020
- Even half a glass of alcohol increases risk of obesity, study shows - Study Finds - September 6th, 2020
- America's Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine - POZ - September 6th, 2020
- 'Fat-Shaming' Drops in US but UK Public Still Apportion Blame - Medscape - September 6th, 2020
- Calls for tougher regulation to fight obesity - Newsroom - September 6th, 2020
- Consumption of alcohol even in small amounts can result in obesity and metabolic syndrome, suggests study - Firstpost - September 6th, 2020
- World's richest countries grappling with children's reading and math skills, mental well-being and obesity - UNICEF - September 6th, 2020
- Definition of Chronic disease - MedicineNet - August 31st, 2020
- America's Move to Raise A Healthier Generation of Kids ... - August 31st, 2020
- Controlled obesity status: a rarely used concept, but with particular importance in the COVID-19 pandemic and beyond - DocWire News - August 31st, 2020
- Groningen University Hospital to investigate role of obesity in patients with COVID-19 - Innovation Origins - August 31st, 2020
- Obesity and COVID-19: How weight tips the scales to severe COVID-19 illness - The Stanford Daily - August 31st, 2020
- Study finds obese people at higher risk of COVID-19 complications - Times of India - August 31st, 2020
- Childhood obesity could increase the risk of multiple sclerosis in later life - The Conversation UK - August 31st, 2020
- Peter Rhodes on an Indian romance, the risks of obesity and standing up for nice things - expressandstar.com - August 31st, 2020
- Joint Pain Injections Market: Investments by key players is driving the global market - BioSpace - August 31st, 2020
- Why your doctor will not talk to you about obesity - The Standard - August 31st, 2020
- EDITORIAL: We haven't tackled obesity - and now it's proving our downfall - Bahamas Tribune - August 31st, 2020